Fluoroscopy-assisted epidural catheter placement: an exploratory analysis of 303 pre-operative epidurograms.

BACKGROUND: Epidural catheters that are placed for post-operative analgesia have a significant failure rate in the first 24 hours. Beginning in 2011, we have used fluoroscopic guidance to place all non-obstetrical epidural catheters. In this retrospective analysis, we hypothesized that the characteristics of dye distribution on an epidurogram obtained immediately after catheter placement would predict clinical catheter function after surgery. METHODS: The epidurograms and medical records of 303 consecutive patients who had epidural catheters placed for post-operative analgesia were reviewed. We extracted data on epidural dye distribution on the epidurograms and compared these results to the clinical function of the epidural catheters assessed on post-operative day 1 (POD1). RESULTS: The three-dimensional pattern of epidural dye distribution (cephalad-caudad, right-left, anterior-posterior) had significant correlations with clinical function of an epidural catheter after surgery. Increased cephalad-caudad and anterior dye spread both correlated with decreased epidural solution infusion rates on POD1, whereas right- or left-sided dye distribution correlated with unilateral sensory deficits. A higher catheter placement on the neuraxis correlated with lower pain scores after thoracic surgery. CONCLUSIONS: An epidurogram obtained immediately after epidural catheter placement may have clinical utility for predicting clinical function of the catheter after surgery.

Neosporosis in a young dog presenting with dermatitis and neuromuscular signs.

A 16-week-old, male boxer dog developed multifocal nodular dermatitis followed by rapidly progressive and fatal neuromuscular disease. Protozoal tachyzoites were demonstrated by aspiration and biopsy of dermal lesions. Necropsy and histology revealed necrotising inflammation associated with intralesional protozoal organisms in various organs including the brain, heart, skeletal muscle and skin. Serology suggested active infection with Neospora caninum. Immunohistochemistry provided a definitive diagnosis. Dermatitis is a finding rarely associated with juvenile neosporosis. The possible role of immunosuppression is discussed.

Informed consent for population-based research involving genetics.

Bridging the gap between gene discovery and our ability to use genetic information to benefit health requires population-based knowledge about the contribution of common gene variants and gene-environment interactions to the risk of disease. The risks and benefits associated with population-based research involving genetics, especially lower-penetrance gene variants, can differ in nature from those associated with family-based research. In response to the urgent need for appropriate guidelines, the Centers for Disease Control and Prevention formed a multidisciplinary group to develop an informed consent approach for integrating genetic variation into population-based research. The group used expert opinion and federal regulations, the National Bioethics Advisory Commission's report on research involving human biological materials, existing consent forms, and literature on informed consent to create suggested language for informed consent documents and a supplemental brochure. This language reflects the premise that the probability and magnitude of harm, as well as possible personal benefits, are directly related to the meaning of the results for the health of the participant and that appropriate disclosures and processes for obtaining consent should be based on an assessment at the outset of the likelihood that the results will generate information that could lead directly to an evidence-based intervention. This informed consent approach is proposed to promote discussion about how best to enable potential participants to make informed decisions about population-based research involving genetics and to suggest issues for consideration by research sponsors, institutional review boards, and investigators.

Assessing the cultural relevance of an education program for urban African Americans with diabetes.

PURPOSE: This study was conducted to assess the cultural relevance of an education program for urban African Americans with diabetes. METHODS: A set of 12 videotape vignettes were developed for use in diabetes education for urban African Americans with diabetes. Focus groups and questionnaires were used to determine if patients and diabetes educators would find the materials stimulating, culturally appropriate, and useful. RESULTS: The videotape and discussion guide were perceived as valuable by both healthcare professionals and patients. CONCLUSIONS: This education program could be a valuable resource for diabetes educators who want to provide culturally sensitive and relevant diabetes education for urban African Americans with diabetes.

Efficacy of lamotrigine in refractory neonatal seizures.

A newborn infant with seizures of unknown etiology that were refractory to treatment with phenobarbitone, phenytoin, midazolam, clonazepam, and vigabatrin is reported. The introduction of the new antiepileptic drug lamotrigine was followed by rapid and sustained control of the seizures.

The reliability and validity of a brief diabetes knowledge test.

OBJECTIVE: To examine the reliability and validity of a brief diabetes knowledge test. The diabetes knowledge test has two components: a 14-item general test and a 9-item insulin-use subscale. RESEARCH DESIGN AND METHODS: Two populations completed the test. In one population, patients received diabetes care in their community from a variety of providers, while the other population received care from local health departments. Cronbach's coefficient alpha was used to calculate scale reliability for each sample. To determine validity, patient group differences were examined. It was hypothesized that test scores would be higher for patients with type 1 diabetes, for patients with more education, and for patients who had received diabetes education. RESULTS: The coefficient alpha s for the general test and the insulin-use subscale indicate that both are reliable, alpha > or = 0.70. In the community sample, patients with type 1 diabetes scored higher than patients with type 2 diabetes on the general test and the insulin-use subscale. In the health department sample, patients with type 1 scored higher than patients with type 2 on the insulin-use subscale. For both samples, scores increased as the years of formal education completed increased, and patients who received diabetes education scored higher than patients who did not. CONCLUSIONS: Although the samples differed demographically, the reliability and validity of the test were supported in both the community and the health department samples. This suggests that the test is appropriate for a variety of settings and patient populations.

Using focus groups to identify psychosocial issues of urban black individuals with diabetes.

The purpose of this focus group research was to identify issues that could serve as topics for a series of educational videos portraying psychosocial issues of urban black individuals with diabetes. Four focus groups involving 34 black adults were conducted in the Detroit area. Psychosocial issues were identified and rated in order of priority by an expert panel. The major psychosocial issues identified were the importance of food and eating in the black culture, the necessity for learning more about diabetes and its complications, learning to interact effectively with healthcare providers and systems, and the need for help and support in managing psychosocial issues related to diabetes. Black individuals with diabetes face unique psychosocial challenges. Focus groups are an effective method for obtaining relevant, culturally specific, in-depth information about living with diabetes from patients who are members of minority groups.

Evaluation of an activated patient diabetes education newsletter.

This study evaluated a monthly, activated patient newsletter sent to over 7000 patients in Michigan with diabetes. The newsletter provided concise and action-oriented information about diabetes care. Patients who had signed up to receive the newsletter during the first 4 months of the project (1863) were surveyed to determine how many patients found the newsletter helpful; 80% (1498) of the patients replied. Patients who found the newsletter most helpful were older; had lower incomes, and reported more complications, less understanding of diabetes, and being in poorer overall health. They also were more likely to have non-insulin-dependent diabetes mellitus (NIDDM) than insulin-dependent diabetes mellitus (IDDM). We concluded that the activated patient newsletter is a useful public health/patient education intervention for persons with diabetes. Such a newsletter should be part of a coordinated system of ongoing patient care, education, screening, and social and psychological support.

Learning to empower patients. Results of professional education program for diabetes educators.

The patient empowerment approach to diabetes education is intended to enable patients to make informed decisions about their own diabetes care and to be fully responsible members of the health-care team. Facilitating patient empowerment requires a specific set of skills and attitudes on the part of diabetes educators. A professional education program designed to facilitate the acquisition and enhancement of the requisite skills and attitudes was designed, implemented, and evaluated. The program involved adhering to a simulated diabetes care regimen for 3 days followed by a 3-day intensive skills-based workshop. The 23 educators who participated in the first two offerings of this program made significant gains in their counseling skills and demonstrated a positive change in attitude.

Empowerment: an idea whose time has come in diabetes education.

We have learned much in the past 10 years about how to help patients to acquire diabetes-related knowledge and skills and how to use strategies to help patients change behaviors. However, the application of knowledge and techniques should be guided by a relevant, coherent, educational philosophy. Empowerment offers a practical conceptual framework for diabetes patient education. Empowering patients provides them with the knowledge, skills, and responsibility to effect change and has the potential to promote overall health and maximize the use of available resources. It is an idea whose time has come for diabetes education.

Role of renin and aldosterone in establishment of electrolyte balance in very low birthweight neonates.

Urine sodium, potassium and chloride excretion, plasma renin activity (PRA) and urine aldosterone excretion (UAE) were measured in seven very low birthweight (VLBW) infants during the first 6 weeks after birth. Hyponatraemia was most common, and major changes in urine electrolyte excretion occurred, during the first 2 weeks. These changes in urine electrolyte excretion appeared to relate to improvement in distal tubular function. PRA did not correlate with urine excretion of either aldosterone or electrolytes. However, UAE correlated significantly with fractional sodium-potassium exchange in the distal tubule in a non-linear fashion (P less than 0.001) which suggested a threshold of aldosterone responsiveness between 70 and 100 nmol/24 h per 1.73 m2 UAE. We conclude that in VLBW infants the distal tubule can respond to aldosterone during the first 2-3 weeks, but that the threshold for responsiveness appears to be higher than it is in fullterm infants.

Effect of diazoxide on the antepartum cardiotocograph in severe pregnancy-associated hypertension.

Intravenous diazoxide was given to 8 patients with severe pregnancy-associated hypertension (diastolic pressure greater than or equal to 110) in the antepartum period. Maternal hypertension was rapidly controlled in all patients; the diastolic blood pressure fell to less than or equal to 100 in all patients and to less than or equal to 85 in 7. Diazoxide had no significant effect on the basal fetal heart rate (FHR) or on the latency period or amplitude of late decelerations in the 3 patients with abnormal (positive) stress cardiotocographs (SCTG) and abnormal (unreactive) non-stress cardiotocographs (NSCTG). In the 5 patients with reactive NSCTGs, diazoxide had no significant effect on the basal FHR or on the frequency of fetal movement-induced FHR accelerations. Thus, diazoxide did not adversely affect fetal well-being in these patients with severe pregnancy-associated hypertension as assessed by cardiotocography.